Sample Taken Date	05/08/2025	Sample Unique Key	4
Will the laboratory/organization for which you are a member perform testing on this material sample?	Yes	Date that the sample was received by the laboratory/organization performing the testing	05/08/2025
Sample type	Quality Assurance	A brief description of the sample	1 x 4 PCC Aggregate
The quantity of what the sample constitutes	40	From where was the sample collected	Supplier
First name of sampler or witnessed by	Eduardo	Last name of sampler or witnessed by	Gomez
Title of sampler		Telephone number of sampler
Laboratory sample identification		Linked DIME Sample ID
The fabricator/manufacturer/facility name	Cemex	Transportation Laboratory (TL) Number
Inspector Lot Number from the Transportation Laboratory (TL) Form		Structure unique identifier
Structure name		Bid Item	Not set

Material Type	Concrete	The concrete mix design number	1629003
The truck number from where the sample was collected		The batch plant ticket number from where the sample was collected	31604837
Concrete batch plant		The fabricator/manufacturer designation for the sample
A detailed description of where the material sample was collected	Discharge from concrete truck into wheelbarrow.	Where the material sample would have been placed if not sampled
From Lot No.		Bag Lot No.

DIME Test ID: 2025-05-08-4-1 ASTM C1064-17 (Verified)
DIME Test ID: 2025-05-08-4-2 ASTM C143-20 (Verified)
DIME Test ID: 2025-05-08-4-3 CTM 521-June 2020 (Verified)
DIME Test ID: 2025-05-08-4-4 CTM 523-May 2020 (Verified)